The email notices come in quite regularly, from sources around the world. The latest one in my inbox is calling for Spanish residents to join a demonstration for “the Transgender, Transexual and Intersexual struggle” on October 7th, in Barcelona. The protest’s aim is for the “complete depathologization of Trans identities” by removing “Gender Identity Disorder” (GID) from medical classification - or perhaps to reassign it.

This would seem a reasonable enough issue, and certainly as a transgendered person myself, it’s quite unnerving that my diagnosis of GID puts me in the same pigeon-hole as things such as schizophrenia or even pedophilia. It’s also quite humbling that while homosexuality was stricken from the Diagnostic and Statistical Manual (DSM) in the early 1970s, transgendered people still carry the stigma of “mental illness.” It takes a while to get past the emotional arguments and personal vanity to really assess this fight.

There is definite cause for concern, don’t get me wrong. When the emotional argument of “mental unfitness” can lead to ostracism, discrimination in the workplace or the loss of custody and/or visitation rights of children, there are some very serious things at stake. But when the lobbies are calling for a reclassification - or more dramatically a total declassification - of GID, one would expect that they had a better medical and social model to propose. They don’t.

The argument for complete declassification is a great concern because, unlike homosexuals, transgendered people do have medical needs and issues related to their condition. There are clear medical applications that some require, where there is risk of suicide from the distress of not having such things available: genital reassignment surgery (GRS), mastectomies and hysterectomies for transmen; tracheal shave, facial hair removal and breast augmentation for transwomen. We need to use caution about taking psychiatry out of the equation because GID really does affect us psychologically, and we do benefit from having a central source of guidance that keeps this in mind no matter how flawed the process might be otherwise.

Declassification of GID would essentially relegate transsexuality to a strictly cosmetic issue. Without being able to demonstrate that GID is a real medical condition via a listing in the DSM, convincing a doctor that it is necessary to treat us, provide referrals or even provide a carry letter that will enable us to use a washroom appropriate to our gender presentation could prove to be very difficult.

Coverage in some regions, or those medical plans that list inclusion, are only possible because of an existing medical classification. Even coverage of, and access to, hormone treatment is called into question in a declassification scenario. And certainly, where coverage is not available, it is the impoverished, disenfranchised and marginalized of our community (who quite often have more to worry about than the stigma of mental illness) who lose the most.

So I would argue that declassification is actually not best for the transgender community. But if anyone who thinks that removing transsexuality as a mental disorder would magically change the way that society views transfolk, is deluding themself.

At some point in the future, I expect that we will find more biological bases for GID, and that transgendered people will perhaps become a smaller part of the larger intersex community (rather than the other way around). Recent studies in genetics have demonstrated some difference in chromosomal structure in male brains versus female brains, and the UCLA scientists who conducted the study have also proposed that their findings are pertinent to a cause of gender dysphoria. Other studies into endocrine disrupting chemicals could open new discoveries related to variance in gender correlation. A reassessment of GID is almost certainly something that will be on the medical community’s table at some point in time in the future, but it definitely needs to remain in the DSM in some capacity.

But for now, GID is not something that can be determined by a blood test or an ultrasound, and is not easily and verifiably identified through biological conditions, which is why reclassification is not yet feasible. It’s difficult to convince scientific and medical professionals to alter a diagnosis when the current model is workable in their eyes (even if not perfect). The alternatives are not yet proven, cannot be demonstrated as more valid than the current listing, and no modified treatment system has been devised. Any move of the diagnosis will not likely be far from the current listing. From the literature I’ve seen, I doubt that the community will be happy with that. For some, even listing it as a “physical disability” could constitute an “unwanted stigma.”

Complacency is still not an answer. In the face of conservative reluctance and new left-wing activism by the likes of Julie Bindel, who claims that GRS is “unnecessary mutilation,” we need to discuss the necessity of treatments in order to ensure that any change would be an improvement on the existing model, rather than a motion to scrap it. This is, of course, something that affects a small portion of the transgender community in the umbrella’s full reach of the term, but the need for those at spectral extremes is profound. It is not simply a question of quality of life, but one of living at all. If and when a reclassification occurs, it will be this sense of necessity that will determine the shape of what will be written into any revision.

Perhaps this issue is what transgender activists on any medical fronts should focus on, for the moment.